Real-World Patient Experience of Switching Biologic Treatment in Inflammatory Arthritis and Ulcerative Colitis – A Systematic Literature Review

Figures & data

Table 1 Study Eligibility Criteria

	Inclusion Criteria	Exclusion Criteria
Population	Adult patients (≥18 years) with IA Adult patients (≥18 years) patients with UC	Pediatric patients Studies with fewer than 20 patients
Intervention	Switching from biologic to biologic; from biologic to biosimilar; from biosimilar to biologic	Studies without biologic or biosimilar treatment
Comparators	No restrictions	No restrictions
Outcomes	Studies reporting reasons for switching and/or discontinuing treatment as noted by: HCP Patient (PRO)	No PROs and/or no HCP-reported reasons for switching and/or discontinuing treatment
Study design	All study designs that include real-world data, observational and interventional studies (prospective/retrospective)	RCTs Editorials Guidelines Case reports Reviews/meta-analyses
Language	English	All other languages
Time period	Publication date from Jan 1st, 2013 to present (October 25th, 2018) Conference abstracts: from 2016 to present*	Publications before 2013 Conference abstracts before 2016
Geographic scope	Europe North America	Continents other than Europe or North America

Note: *Only most recent conference searched.

Abbreviations: HCP, healthcare professional; IA, inflammatory arthritis; PRO, patient-reported outcome; RCT, randomised controlled trial; UC, ulcerative colitis.

Figure 1 PRISMA study selection flowchart.

Figure 2 Treatment sequences of included studies. (A): Distribution of treatment types by position in treatment sequence in patients with IA and UC, respectively. (B): The number of studies reporting treatment transitions in patients with IA and UC, respectively.

Notes: ^†Some studies include more than one treatment type for each part of the sequence; hence, at each part of the sequence, the number of treatment types is greater than the number of studies. *Includes “Biologic therapy”, “TNFi”, and “bDMARD”. ^⁑Includes treatment switching between first and second treatment, and between second and third treatment, in the sequence, respectively. ^‡Second treatment type stated as “biologic therapy” only.

Abbreviations: bDMARD, biological disease-modifying antirheumatic drug; IA, inflammatory arthritis; TNFi, tumor necrosis factor inhibitor; UC, ulcerative colitis.

Table 2 Patient Experience of Switching

Author, Year	Switch	Patients (n)	Indication	Country	Patient-Reported Switching Experience
Attipoe 2018^Citation36	ETA biologic → ETA biosimilar	107	AS: 11% PsA: 16% RA: 68%	UK	Excellent	Very good	Satisfactory	Poor	Very poor
					45%		44%	9%
Scherlinger 2018^Citation27	Enbrel → SB4	52*	RA: 38% SpA (incl AS, PsA, and SAPHO): 62%	France	Good
					86%
Shah 2018^Citation77	ETA biologic → ETA biosimilar	155	RA	UK	Pleased	Indifferent	Not sure	Not pleased	No answer
					43%	7%	8%	23%	18%
Hoque 2018^Citation57	ETA biologic → ETA biosimilar	94	RA/PsA/SpA	UK	No problem with switch
					62%

Note: *44 patients switched treatment from Enbrel to SB4.

Abbreviations: AS, ankylosing spondylitis; ETA, etanercept; PsA, psoriatic arthritis; RA, rheumatoid arthritis; SAPHO, synovitis-acne–pustulosis–hyperostosis–osteitis syndrome; SpA, spondyloarthritis; UK, United Kingdom.

Figure 3 Patient-reported outcome measurement tools used. The number above each bar denotes the number of studies using each particular PRO measurement tool. The four studies reporting patient experience of switching treatment (“Ranking” bar) are highlighted in dark grey.

Abbreviations: HAQ, Health Assessment Questionnaire; VAS, Visual Analogue Scale; PGA, Patient Global Assessment; RAPID3, Routine Assessment of Patient Index Data 3; TSQM, Treatment Satisfaction Questionnaire for Medication.

Table 3 Reasons for Switching and/or Discontinuing Biologic Originator or Biosimilar Treatment

	Adverse Events	Loss of Efficacy	Remission	Patient Preference	Other
Reason for Switching Treatment
Unweighted mean	23%	52%	N/A	14%	34%
Median	22%	53%	N/A	7%	34%
Range	2–63%	2.5–98%	N/A	1.9–44%	5–67%
Reason for Discontinuing Treatment*
Unweighted mean	25%	48%	10%	10%	18%
Median	23%	50%	4%	9%	15%
Range	4.4–77%	6.3–92%	0–52%	4–16%	2–55%

Note: *These data may or may not include patients switching treatment; not always evident from the reported information.

Abbreviation: N/A, not applicable.

Figure 4 Risk of bias assessment scores. The number shown above each bar denotes the number of publications receiving a particular score.

Attipoe L, Patel S, Birt R, Crooks J, Hunt K, Grigoriou A. What factors predict good patient experiences of switching from reference etanercept to an etanercept biosimilar in a south west london general hospital? Rheumatology. 2018;57(Supplement 3):iii63.

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Scherlinger M, Langlois E, Germain V, Schaeverbeke T. Acceptance rate and sociological factors involved in the switch from originator to biosimilar etanercept (SB4). Semin Arthritis Rheum. 2019;48(5):927–932. doi:10.1016/j.semarthrit.2018.07.005

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Shah K, Flora K, Penn H. Clinical outcomes of a multi-disciplinary switching programme to biosimilar etanercept for patients with rheumatoid arthritis. Rheumatology. 2018;57(Supplement 3):iii143–iii144.

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Hoque T, Suddle A, Herdman L, Kitchen J. Patient perceptions of switching to biosimilars. Rheumatology. 2018;57(Supplement 3):iii67–iii68.

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